Differences in the utilization of physical therapy for outpatients with non-specific shoulder pain labels and specific shoulder pain labels.

BACKGROUND: National data on the characteristics of ambulatory visits with non-specific shoulder pain (NSSP) labels are lacking. The aim of this study was to identify the differences in the utilization of physical therapy (PT) for visits with NSSP labels and visits with specific shoulder pain (SSP) labels by using National Ambulatory Medical Care Survey (NAMCS) database. METHODS: The NAMCS was queried from 2007 to 2016 to identify the ambulatory visits for shoulder pain. The study population was stratified according to the top 3 diagnoses, including NSSP group and SSP group. Data on patient, practice and visit characteristics were included, as variables in both descriptive and adjusted analyses. Differences in these characteristics and clinical management for the two groups were tested. Multivariable logistic regression analyses were employed to identify the association between the diagnosis type and utilization of PT. RESULTS: An estimated total of 86.49 million adult ambulatory visits for shoulder pain were identified in this study. Of these, 24.31 million visits (28.1%) were assigned to NSSP labels. Combining all years, PT was prescribed in approximately 10.8% of visits with NSSP labels, which was significantly lower than visits with SSP labels (22.2%). After adjustment for covariates including age, sex, race, expected source of payment, metropolitan statistical area (MSA), major reason for this visit, injury related, referred for this visit, continuity of care, number of medical comorbidities, and physician specialty, visits assigned to NSSP labels had significantly lower odds of prescribing PT compared to visits assigned to SSP labels (adjusted OR = 0.62, 95% CI: 0.41-0.94). CONCLUSIONS: The results of this retrospective cross-sectional study identified the significant differences in the utilization of PT for ambulatory visits with NSSP labels and SSP labels by using NAMCS database. These findings may help diminish management disparities and improve appropriate use of PT in the ambulatory management of shoulder pain.